RESUMEN
OBJECTIVE: To evaluate the acceptability of a cancer care team based at an Australian Aboriginal medical service in supporting patients' cancer journeys and to assess improvements in access to cancer care. DESIGN: The cancer care team consisted of an Australian Aboriginal health worker, counsellor and enrolled nurse employed for 2 days a week, supported by a general practitioner. The cancer care team supported patients from prediagnosis while investigations were being undertaken, at diagnosis and through treatment, such as surgery, chemotherapy and radiotherapy, and follow-up, including to palliative care and grief support where these were required. They coordinated preventive programs, such as cervical smear and mammogram recall registers, and coordinated health promotion activities to promote prevention and early detection of other cancers, such as bowel cancer, skin cancer, liver cancer and prostate cancer. The program was evaluated qualitatively using semistructured interviews with current clients of the cancer care team and stakeholders, using grounded theory to analyse emerging themes. SETTING: An Australian Aboriginal community-controlled health service in New South Wales. PARTICIPANTS: The cancer care team provided care for 79 clients. MAIN OUTCOME MEASURES: Acceptability and accessibility of cancer care services. RESULTS: The evaluation involved recruitment of eight Australian Aboriginal clients of the cancer care team and eight stakeholders. The main themes to emerge included improved accessibility of cancer care services, including availability of home visits, transport and accompaniment to tertiary settings. The service was viewed as being culturally safe. CONCLUSION: A primary care-based cancer care team in an Australian Aboriginal medical service provided a culturally safe and accessible service for clients.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Competencia Cultural/organización & administración , Servicios de Salud del Indígena/organización & administración , Neoplasias/terapia , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Anciano , Anciano de 80 o más Años , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricosRESUMEN
Many aspects of the treatment for adolescent depression are still uncertain. However, our body of knowledge continues to accumulate, and our approaches continue to be refined. When we remember that 40 years ago the field was still arguing about the existence of depression in youth, it is clear that significant progress has been made. Recent controversies have provided another opportunity to step back and re-evaluate. Given the chronicity, morbidity, and mortality associated with adolescent depression, the risks of doing nothing are too great. Evidence-based research has provided us with some direction during this unsettling time. After careful reviews, the major professional organizations representing pediatric medicine and psychiatry all support the continued use of SSRI antidepressant medications but emphasize close monitoring. The debates also have heightened interest in effective psychotherapy approaches, particularly CBT and IPT. Given the risk for suicidality in depressed adolescents, assessment and management of safety concerns remain critical, regardless of medication usage. Above all, it is most important that we remain hopeful about our ability to guide adolescents and families through the struggles with depression toward recovery.
Asunto(s)
Depresión , Adolescente , Antidepresivos/uso terapéutico , Imagen Corporal , Comorbilidad , Depresión/diagnóstico , Depresión/epidemiología , Depresión/terapia , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Desastres , Indicadores de Salud , Humanos , Salud Mental , Educación del Paciente como Asunto , Prevalencia , Pronóstico , Psicoterapia , Pubertad/fisiología , Factores de Riesgo , Suicidio/psicología , Suicidio/estadística & datos numéricosRESUMEN
We characterized the diversity of sulphate-reducing bacteria (SRB) associated with South African gold mine boreholes and deep aquifer systems in Washington State, USA. Sterile cartridges filled with crushed country rock were installed on two hydrologically isolated and chemically distinct sites at depths of 3.2 and 2.7 km below the land surface (kmbls) to allow development of biofilms. Enrichments of sulphate-reducing chemolithotrophic (H2) and organotrophic (lactate) bacteria were established from each site under both meso- and thermophilic conditions. Dissimilatory sulphite reductase (Dsr) and 16S ribosomal RNA (rRNA) genes amplified from DNA extracted from the cartridges were most closely related to the Gram-positive species Desulfotomaculum thermosapovorans and Desulfotomaculum geothermicum, or affiliated with a novel deeply branching clade. The dsr sequences recovered from the Washington State deep aquifer systems affiliated closely with the South African sequences, suggesting that Gram-positive sulphate-reducing bacteria are widely distributed in the deep subsurface.